Health care in France - another U-turn by Sarkozy

Changes in French health care for ex-pat early retirees

Good news for early retired ex-pats

Everyone likes to hear good news, and hot on the heels of the recent French government U-turn on extra taxes for holiday homes (French Tax on Holiday Homes Dropped - the law was forced out before it could come into play) comes the announcement that yet another U-turn has been made. This time the U-turn means that ex-pats who have taken early retirement can enter the French health care system (Health care in France), even if it is cautiously said to be "on a case by case basis" only.

Who is affected?

Those affected by this change are the "early retirees" or those who moved to France before reaching official retirement age and who have not taken up jobs (Jobs in France) or been active in business since their move (Owning Gîtes and Chambres D'Hotes (B&Bs) in France, Working in France). Not everyone will have access to cover, however, even under the changes, so it is important to establish your exact position.

How does the French health care system work?

French residents (and now all EU nationalities who are currently or become resident in France), who do not work or are on low incomes, are entitled to join the CMU (Caisse Maladie Universelle). The CMU allows for reimbursement of around 70% of medical bills and treatments, although this can vary according to the specifics of each case. It costs 8% of a person's worldwide income to affiliate to the CMU, in normal circumstances, with exceptions made for those on extremely low incomes or without financial resources. The situation for ex-pat residents from the EU who are in work is different, as they pay into the system to gain their entitlement.

Previously access to the CMU was restricted

In 2007, a decision was taken to restrict access to the CMU, the national health care system in France for non working or low earning residents. The decision was not wholly unjustified, as France had been suffering from considerable abuse of its system, however, the move made life very uncomfortable for many ex-pats. It meant that instead of being able to take advantage of a subsidised health care system, they had to take out expensive private insurance to meet their health needs.

Some people forced to return to the UK

Even worse, and placing some in a completely untenable position, those with existing, serious health problems were unable to obtain any affordable private insurance at all. It also actively prevented people in this situation with established medical needs from moving to France, and set in motion a train of people forced to return to the UK.

Rules now relaxed

Due to pressure from the EU, which decided that the 2007 ruling was out of line with free movement of people and pensions within the European Union, the announcement has now been made to relax the rules. It means that EU nationals who live in France and are not covered for their medical insurance by the new form S1 (formerly E121 and E106), will enjoy the same access to the CMU as French nationals in a similar situation.

Statement from the Direction de la Sécurité Sociale

A new ministerial circular is to be released, about which the following statement issued by the Direction de la Sécurité Sociale says: "It clarifies the different ways in which an inactive EU citizen can live legally in France through French health insurance, bearing in mind new regulations on coordination or national legislation or a private policy with a range of care comparable to the state's... "etc. "A case by case examination of people's situations will, if necessary, allow access to the CMU."

For more information

The following website offers an updated position (www.securite-sociale.fr/comprendre/europe/europe/cmu_inactifs.htm), or you can call an English speaking CPAM (French health care) service on +33 8 20 90 42 12. There is also a website and helpline for France's centre for European and International Liaisons for Social Security, or CLEISS (http://www.cleiss.fr/, tel: +33 1 45 26 33 41). It is strongly recommended that you clarify your individual position.

However, the situation when the official circular is released should be broadly as follows:

- All those who were resident in France and accessing the CMU before the changes in 2007 can rejoin and receive the same level of benefit as they had then. This is the most positive of the changes, and will come as a relief to those affected by the 2007 restrictions.

- All those EU ex-pats who have been resident in France for five (uninterrupted) years will have access to CMU.

- People who are post retirement age and hold registered E121 forms will remain able to access health care as ever.

- People who suffer from chronic conditions or have debilitating illnesses are now invited to appeal to become eligible for state health care.

Clarification still needed in certain areas

However, there are grey areas surrounding those who find themselves in the position of relying on an E106 form that is about to expire, potentially leaving them without access to medical care which may be vital. Also, at the moment, it seems that those who do not qualify under the above provisions, and who have been existing on their private insurances will have to continue to do so until they reach official retirement age, unless further changes are announced. Questions and concerns regarding this have been raised, and clarification is expected.

What will this mean for the French property market?

Given that a significant number of British people affected by the 2007 restrictions on health care were forced to relocate back to the UK, it follows that the new announcement might reopen the doors for such people. There has been, to date, no offer of compensation for those forced to make expensive and distressing moves or to take out expensive private plans for the last four years, and it is unlikely that we will see an opening of the floodgates and a mass exodus from the UK. Perhaps a trickle may return, if their eligibility is now re-established, but others may find their five-year uninterrupted residency compromised. The market may however pick up on the grounds that France is being forced in general to take positions in line with European policy, offering hope of a fairer system for all aspects of life for ex-pats.

Additional articles which may be of interest:

About the author

Joanna Simm moved to the Languedoc area of south-west France in October 2004 having found her property through French Property Links.

your questions...

1. A question about an unfair demand for Prelevements Sociaux (added 8/12/11)...

I came to live in Lodeve 34700 Herault, Langedoc in May 2006. I had a job as an Aide de chef with a Contract Determinee for one year from September 2006. On this basis I applied for and was given a carte vitale. At the end of the contract in September 2007, I received "Assedic" assurance at 80% of my income for a further one year, until 2008. I continued to recieve my health care on that basis and as I had been employed. From 2006 I returned an annual Imposition D'Impot,
the details of which were related to this former employement and to the subsequent income from Assedic. As you know declarations are one
year in arrears in the French system.

For the year 2010 I was without any health care, but was advised by the local office of Assurance Maladie to apply on the basis of residency of five years from May 2011. This I did and was immediately successful and with no complications or difficulties. I am 61 years old, and not yet retired officially or in receipt of a UK pension, so
the carte vitale was not issued on that basis but on the basis of residency of five years.

In 2010 I declared in my annual Avis D'Imposition ownership of a property bequethed to me in England. Tax is paid on the rental income
of this property in the UK. Therefore I was "zero rated" for tax here. So far so good.

This year in October 2011 I received a demand for Prelevements Sociaux for the year 2010/11 of 14%, (amounting to 1,400 Euros) of the Revenue
Fonciers which I declared as income in the UK, on which due to the Strasbourg Convention (EU) taxation legislation you cannot be taxed
twice. I immediately went to see the local chief tax inspector and explained that this demand was an error and should be cancelled. He
refused to do this, stating that "English people such as myself, who are not yet of retirement age" (in my case 65) were "costing the French state money, and as I was not retired and getting a UK pension", which would have meant that my health care was paid by UK directly, I had to pay the Prelevement Sociaux as "my contribution to the debt of France". I felt that this must be wrong, and that his views were personal and not based on law. I did not believe that there was any relationship between the Assurance Maladie, and my rights to health care as a resident, and the newly imposed Prelevement Sociaux. Never the less I paid the tax by 15 November 2011.

A few days later I met some English friends who had received the same demand for Prelevement Sociaux, and who also had a house in the UK
from which they derived income, tax on which was paid in the UK. They had just come from the same tax office, having seen the same tax inspector and he granted them an annulation of the demand. Naturally they were happy with the outcome of their meeting. I went immediately back to this tax inspector and informed him that I was in the same
position exactly as my friends whom he had seen earlier that day. He then made excuses that he had thought I had a property in France on which the PS would have been payable. His excuses were not at all convincing. He granted me an annulment which he said I would receive within a month as a Virement to my bank account or as a cheque. I asked him if he could do this now in my presence, he said "it was not him" but a colleague who would do it. I asked him to give me a note of our
meeting with a stamp of the date which he declined to do.

As I left the room he said that "I should really get an attestation from the Assurance Maladie, that the English were paying for my health
care not the French" and further stating that "he had to pay for his health care and so should I". These were evidently his personal views. I
await to see if I do in fact receive this refund. I asked him if he wanted such a document now, before giving me the annulation and he
said "no, but just make sure you have it in the future". He seemed to be conducting a personal campaign of some kind. I await to see if I do
get this money back.

I have established from the Assurance Maladie, and local French accountants, that there is no connection or relationship between my rights to health care as a resident, and the imposition of this tax which is clearly incorrect. Do you have any knowlege of such a connection and any reports of experience of others in my position, or do you have any advice which might be helpful?

Jo Rhodes, editor of French Property Links replies...

Thanks for contacting us and relating what has happened to you. It was very interesting to read, but I have not heard of this happening before.

For further advice, you may wish to contact the following who may be able to shed more light on the subject: